Evaluation of Workplace-based Quit Smoking Programs Check-in Survey for Employers 1
Questions about your organization: Name of Organization: 1. What is your role in this organization? 2. Under which sector does your organization fall? (Please check all that apply) a. Manufacturing b. Construction c. Mining d. Hospitality and Service e. Other, (please give details ) Questions about the quit smoking activities currently being offered at your organization: 3. To the best of your knowledge, please use the following categories to describe the quit smoking activities currently being offered at your organization under the Workplace Smoking Cessation Project. This information is important to help us understand how the activities are working in your organization. 3 a. Organizational resources required to run the quit smoking activities (i.e., trained staff, partnership with Public Health) 3b. Recruitment activities (i.e., getting employees to enroll in the program) 3c. Cessation support activities (i.e., competitions and contests, NRT, peer support, counselling) 2
3d. Capacity building activities (i.e., training EAP staff) 3e. Workplace policy development activities (i.e., smoke-free grounds, benefits coverage) 3f. Logistical information (i.e., timeframe, frequency and location of support provided) 3g. Any other useful information (i.e., collaborations with other programs or services) Questions about the planning and development of your organization s quit smoking activities under the Workplace Smoking Cessation Project 4. Please describe how your organization was involved with the planning and development of the current quit smoking activities under the Workplace Smoking Cessation Project. 5. What was most helpful for your organization during the planning and development of the current quit smoking activities? 3
6. What challenges or issues did your workplace experience with the planning and development of the current quit smoking activities? 6a. How were the challenges or issues with the planning and development of the current quit smoking activities addressed? 6b. Please describe any concerns about unresolved challenges or issues with the planning and development of the current quit smoking activities. 7. If you could change anything about how the current quit smoking activities at your workplace were planned and developed, what would you change and why? 4
Questions about implementing your organization s current quit smoking activities under the Workplace Smoking Cessation Project: 8. Has your organization been involved with implementing (as in actively executing) the current workplace quit smoking program? a. yes b. no Skip to question 13 9. Please describe how your organization has been involved with implementing the current workplace quit smoking program. 10. What has been working well with the implementation of the current workplace quit smoking activities at your organization? 11. What challenges or issues has your organization experienced with the implementation of the current quit smoking activities? 5
11a. How are the challenges or issues with the current quit smoking activities being addressed? 11b. Please describe any concerns about unresolved issues with the implementation of the current quit smoking activities at your organization. 12. Did your organization make any adjustments to the original plans for the current workplace quit smoking activities? a. yes b. no Skip to question 13 12a. If yes, please describe the adjustments and explain why they were made. 6
Questions about early successes with your organization s current quit smoking activities under the Workplace Smoking Cessation Project: 13. Based on your experiences so far, do you think that your organization s current quit smoking activities are helping employees address their tobacco-related goals? a. yes b. no Skip to question 13b 13a. What seems to be helping employees the most to reach their tobacco-related goals? 13b. Can you think of any reasons why your organization s current quit smoking activities are not helping employees address their tobacco-related goals? 14. Based on your experiences so far, has your organization s current quit smoking activities led to any unintended changes or consequences (positive or negative) at your workplace? a. yes b. no Skip to question 15 14a. Please explain the unintended changes or consequences (positive or negative) at your organization as a result of the current quit smoking activities. 7
15. Do you have any other comments or questions? Thank you for completing this survey! 8